scrotal problems

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Scrotal Problems

Dhika Ari Rizki,dr



Introduction

The scrotum is a protuberance of skin and

muscle containing the testicle.

Function is to regulate the temp of thetesticles through the cremaster muscle

and the dartos fascia in the scrotum.

Ideal temp is about 34.4, > 36.7 maydamage sperm count.



Copyright ©1996 BMJ Publishing Group Ltd.

Davenport, M. BMJ 1996;312:435-437

Incidence of common causes of acute scrotal problems in infants and children.



Rarer causes in children

Henoch – Schonlein purpura

Leukaemia

Scrotal hyperpigmentation – congenital

adrenal hyperplasia

Epididymo-orchitis



Acute scrotal pain

Causes;

Acutely painful scrotum is torsion of testis until provenotherwise.

Strangulated inguino-scrotal hernia is tender, painful,irreducible groin lump.

Torsion of the hydatid of Morgagni

Acute epididymitis

Haematocoele - trauma or scrotal surgery

Fournier’s gangrene-necrotising fasciitis Appendicitis - referred pain (same visceral afferent nerve

supply as testis - T10)



Chronic scrotal pain

Causes;

Inflammation

Chronic bacterial epididymitis

Recurrent incomplete testicular torsion

Chronic scrotal discomfort-in absence of infection. Often hx of scrotal surgery or

trauma.

TB



Testicular torsion in newborn infant

Twist of the whole spermatic cord due to unfixed natureof newly descended testis.

Almost all of such torsions present late with overttesticular necrosis

Pain and tenderness are not prominent.

scrotum usually red and swollen and contains hard

testicular mass surgery to excise damaged organ and to fix other testis.



Testicular torsion in older boys and

adults Many cases yearly of ‘epididymitis‘ treated with antibiotics.

Slight left sided bias, incidence higher in winter months

Major predisposing factor is undescended testis

Symptoms include severe testicular pain which may radiate to thegroin +/- nausea and vomiting.

Examination - gentle. high riding or horizontal testis. No specific pathgnomonic clinical signs to differentiate from epididymitis.

Treatment - successful testicular salvage highly dependent on timeb/w start of symptom and surgery. Detorsion and fixation of viabletestis. contra lateral testis fixed at same time.


http://slidepdf.com/reader/full/scrotal-problems 11/22Copyright ©1996 BMJ Publishing Group Ltd.

Davenport, M. BMJ 1996;312:435-437

Rates of testicular salvage by time from start of symptoms.



Scrotal swellings May or may not be confined to scrotum

The cardinal sign of true scrotal swelling is

that it is possible to get above it.

Cystic masses transilluminate, solid

masses do not.



Cystic scrotal swellings

Separate from testis

- Epididymal cysts

- Spermatocoele

Testis lies within swelling

- Hydrocoele-Haematocoele - does not transilluminate



Solid scrotal masses

Separate from testis

-Acute/chronic epididymitis

-Torsion of hydatid of Morgagni

Within the testis

-Testicular tumour

-Torsion of testis

-Orchitis- bac/viral (mumps,influenza,TB,STD)

-Testicular gumma



Scrotal mass not confined to

scrotum

Examiner is unable to get above

- Inquino- scrotal hernia

- Varicoecoele of the pampiniform plexus

- Encysted hydrocoele of the spermatic cord



Hydrocoele

Result of excessive fluid in tunica vaginalis

Congenital/acquired

Primary - occur in absence of disease in testis. Tends to be largeand tense. Common in young boys.

Secondary - represent a rxn to testicular pathology - tumour,infection, and torsion

Presentation is usually as a soft non tender and cystic swelling inscrotum which transilluminates. One can get above lesion. Testislies within fluid collection and is not palpable

Conservative mgt. Scrotal support. Refer if symptomatic or children> 1 yr. needle aspiration, surgery.

Secondary- Rx underlying cause



Varicocoele

Varicose veins in the pampiniform plexus of thespermatic cord and scrotum.affects 15 - 20% of males.rare after 40yrs.

Most are asymptomatic found during investigation for infertility in 40 % males.

Pelvic mass compressing venous drainage of testicle

Dull ache at the end of the day or following exercise

Dragging or feeling of heaviness Visible on standing and feels like a ‘bag of worms’. Pos

cough impulse. Disappears when recumbent.

Surgical intervention only if painful, infertile or testicular atrophy



Testicular tumours

Most common cancer in men ages 20 – 40

Most growths in scrotum are benign.

However take seriously painless lump in scrotum or in

testicle or unexplained pain in one testis. Presence of hydrocoele.

Mass is hard and does not transilluminate

Predisposing factor is hx of undescended testis

Urgent referral under 2 wk rule.- tumour markers LDH, AFP and HCG

NICE GUIDELINES-refer pts with a swelling or mass inbody of testis. Consider urgent USS in men with scrotalmass that does not transilluminate and when body of testis cant be distinguished



Epididymitis

Inflammation of epididymis +/- orchitis

Predisposing factors ;UTI,Urethral instrumentation,

STI; E.coli and Chlamydia with hx of discharge

CF- pain and swelling, inflammation, fever +/- rigors.Prehn’s sign - scrotal elevation relieves pain

Secondary hydrocoele

Clinically indistinguishable from torsion

Inv –fbc,blood culture,msu,plain abdo xray, IVU/USS

Rx –rest, scrotal elevation, broad spectrum abx,nsaidand non exertion for 1-3 wks



Other causes

Idiopathic scrotal oedema

CCF

Kidney/liver disease

Contact dermatitis

Yeast infection


http://slidepdf.com/reader/full/scrotal-problems 21/22Copyright ©1996 BMJ Publishing Group Ltd.

Davenport, M. BMJ 1996;312:435-437

Epididymitis: swollen, tender, non-transilluminable scrotum in 18 month old child (top)and the underlying acute epididymitis (bottom).



Davenport, M. BMJ 1996;312:435-437

Scrotal bruising due to idiopathic haemorrhage in a 3 day old infant.

scrotal problems

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